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Sustaining Health Professionals



The predicted world-wide pandemic outbreak of a new strain of influenza virus would be a potentially catastrophic event for health care providers who already face stressful working conditions, low morale and high rates of burnout. This pilot research project used both qualitative and quantitative methods to better understand the needs and concerns that health care providers identify as important to their resilience and ability to work effectively during a pandemic influenza.

In total, 52 individuals from a variety of front-line, administrative, and professional roles participated in one of 8 focus groups at a large, urban hospital over a seven month period . Participants were given a detailed presentation on the predicted course of a pandemic influenza, then engaged in guided discussions focused on the needs and concerns arising in light of this presentation.

To understand the effect on anxiety, participants completed the State Trait Anxiety Inventory – state (STAI-s) before and after the pandemic information presentation.  Six themes emerged in focus group discussions: Relationship between work and home; Emotional impact, psychosocial support; Leadership authority and difficult decisions; Communication; and Supplies. The quantitative measure revealed that participants experienced a large increase in anxiety as a result of the pandemic information presentation. The findings point to how specific aspects of pre-planning, preparation and support initiatives, as well as training and orientation programs, could be addressed in order to better prepare and support health care practitioners for future pandemics.

ICISF 2009 Presentation Pandemic Influenza [pdf]
Sustaining Health Care Professionals During Pandemic Influenza: A Pre-incident Pilot Project [link]

To learn more, please contact Dr. Paul Whitehead by email at pwhitehead@providencehealth.bc.ca


A retrospective chart review was completed with the first 80 closed charts of healthcare practitioner who sought individual service at CPR. The findings will be uploaded here soon.


The Centre for Practitioner Renewal (CPR) at Providence Health Care (PHC) is a unique clinic that offers in-house doctoral-level psychological services for health care providers (HCPs). The first 80 closed client charts are reviewed here to understand the experiences of HCPs and to assess treatment effectiveness. Thematic analysis (Braun & Clark, 2006) was used to identify patterns and create themes from the data. This article focuses on the data related to intrapersonal, interpersonal and systemic work-related issues raised by clients. The data suggests that CPR is a cost-effective service that works at the individual, team, and institutional levels to effect change and sustain HCPs.


Psychological safety in the Canadian workplace is increasingly becoming a legal requirement where employers have a duty to maintain a psychologically safe work environment in addition to the more commonly accepted physically safe work environment (Shain, 2009; 2010).

Psychologically healthy workplace models have been proposed by the American Psychological Association (APA; APA, 2010) in the United States, and by Kelloway and Day (2005) in Canada. Although similar to APA, the Canadian model puts more focus on the importance of healthy relationships at work by stressing the need for a culture of support, respect and fairness; and healthy interpersonal relationships.

Research Questions:

  • What is the effect of working in healthcare?
  • What are the referral reasons for seeking services at CPR?
  • What are the common underlying themes brought to counselling at CPR by HCP?


  • A retrospective chart review was conducted on 74 closed charts of clients seen by clinicians at CPR. The files reviewed included all closed files from CPR’s first 5 years. The clients for whom treatment was ongoing were excluded. Thematic analysis yielded 5,739 data items extracted from the charts that were organized into 1,475 codes created to capture intrapersonal, interpersonal and systemic components across clients who received short-term (1-6 sessions), mid-term (7-15 sessions), and long-term therapy (16+ sessions) . Intrapersonal and Interpersonal concerns are reported here. Intrapersonal issues were internal emotions, thoughts, and traits with which clients were coping. Interpersonal issues were experiences clients had with others either at work or outside the work environment. All personal and identifying information was deleted from the charts prior to the review.


  • Considering the referral reasons and the underlying concerns, it is clear the most significant concern for HCPs who sought psychological help was about the nature of the relationships the HCPs were in. Emotional reactions about work, belonging, romantic relationships, and work-related incidents were the concerns reported at the highest frequency.
  • Although the purpose of the CPR chart review was not to shed light on organisational issues faced by HCWs at PHC, a large amount of data related to human resource, management, leadership, and workplace communication concerns was nonetheless offered by clients. The picture that emerged is one of distress as workers are trying to be productive, creative, and engaged while feeling anxious, afraid, alienated, threatened, demeaned, betrayed, and burned out due to organisational policies and practices. Further, lack of confidence in themselves and their work skills does not translate into high quality patient care. The working conditions/work-related issues themes paint a picture of a workplace struggling with workload, leadership, interpersonal/team, communication, and abuse issues that are contributing to the workers’ difficulties.


  • Relationships at work require focused attention (with colleagues and self)
  • Provide in-house psychological services from doctoral-trained people who know healthcare
  • Culture needs to support time for self awareness and time for team process
  • Establish a Team Charter (explicit team agreement) to determine how individuals on a team will work together
  • Directions for future is in proactive interventions
  • Normalizing the range of emotions at work and training how to express difficult emotions

To learn more, please contact Dr. Douglas Cave by email at:




Physician burnout and risk to physician resilience is well-known. Based on the FIFE technique used by physicians with patients as described by Stewart, et al. (2003), this self FIFE tool is designed to increase physician resilience by improving symptoms such as anxiety, depression, hopefulness, and agency. While Physicians are trained to ask patients what the patient feels, thinks, experiences as an effect and expects regarding their chief complaint, physicians are not trained as thoroughly to reflect on themselves. In his research on physicians experiences of working with patients, Whitehead (2012) identified the need for physicians to use an emotional and functional disconnect while working. His research identified that an emotional and functional reconnect was noticeably absent. Research on mindfulness suggests that a daily practice of mindfulness contributes to health numerous ways (Khoury, et al. 2013).  It may also help reconnect a physician to him/herself after very appropriately disconnecting from themselves in a functional manner (Whitehead, 2014). The self-FIFE innovation is designed to be a daily practice that takes a few minutes each day. For the purpose of this pilot, measures of helplessness, depression, burnout, and life satisfaction were administered. The results of the pilot suggests using self-FIFE made improvements in several spheres.


Traditional mindfulness tools require practitioners to pause and meditate for 30, or so, minutes each day. Given the busy and highly scheduled personal and professional lives of many physicians, it is hard for them to carve out the time required for this approach to meditation.

Self FIFE tool is designed to be quick and easy to insert into and maintain in a busy daily schedule. With 4 guiding questions for reflection that address the same 4 domains assessed in patients by physicians; self FIFE is designed to help a physician quickly and easily be mindful of her/his experience.

3 Steps to Resilience

1)   Motivation to self-reflect and develop insight

2)   Memory cues as a reminder to emerge from daily routines

3)   A tool to help self-reflection/self-awareness


  1)  Motivation is assumed based on resilience being helpful for sustainability  

  2)  Memory Cues

    • Hand washing
    • Going to the toilet
    • Closing the office door at the end of the day
    • Sitting in a particular chair
    • Pulling a chart out of the door holder
    • Checking off a patient’s name on the day sheet
    • Logging into or out of the EMR program
    • Placing a chart into the folder for filing
    • Self-FIFE Tool

4 Self-FIFE questions:


What do you feel about yourself/patient/colleague? (The last noun is interchangeable)

Impression (ideas):

What is your impression (judgment) of yourself regarding your patient/work/colleague?


What effect does this patient/work/colleague have on you?


What expectations about yourself are you expressing and what expectations about your patient/work/ colleague are you experiencing?

As with traditional mindfulness, the noticing that comes from reflection is intended to spark action to change any experience that is a detracting experience for the practitioner.


This pilot was funded by the Department of Community and Family Practice at Providence Health Care in Vancouver, BC. For this pilot, family physicians were recruited for the 8-week protocol via word of mouth and departmental newsletter. Of the more than 20 who said they were interested in participating, 5 followed through with the 8 weeks.

Participants were administered psychometric measures as pre and post test tools to assess the effect size of the protocol. The Beck Helplessness Scale, Beck Depression Inventory II, Mazlac Burnout Inventory, Stait-Trait Anxiety Inventory and the Life Satisfaction Scale were combined with a demographic survey to collect data.


From this small pilot study and as measured by Cohen’s d, the participants’ self report indicated there is a large and positive effect on several scales. The scales that measure hopelessness, depression and state anxiety reflect a large and positive effect. This is consistent with other studies including Khoury, et.al. (2013) which show similar results. The participants’ self report reflects a medium effect on the Satisfaction With Life Scale. This result suggests there is a positive effect on the participants’ satisfaction, but that effect is medium. This may be explained by the results on the Mazlac Burnout Inventory.

The Mazlac Burnout Inventory reflect interesting findings. The 3 subscales of the inventory reflect a large and negative effect on burnout and depersonalization and a medium and positive effect on personal achievement. The burnout subscale measures emotional exhaustion. The depersonalization subscale measures: 1. A negative attitude towards clients, 2. Personal detachment, and 3. Loss of ideals. While any conclusion is speculative, these result may be due an increased awareness of emotional exhaustion as a result of pausing and taking notice of emotions. These negative results are balanced with the medium and positive result on the personal achievement scale which measures a sense of agency and accomplishment.


  • Even a few minutes of regular mindful reflection has a positive effect
  • A memory cue is useful as a reminder to self reflect
  • A pre-selected memory cue is helpful
  • A pre-established set of questions was very useful
  • Even a few minutes of mindful reflection has a positive effect on depression, hopelessness satisfaction with life and a sense of personal achievement.

To learn more, please contact Dr. Douglas Cave by email at: